Clinical Stories with Issues of DV: An Open Forum Talking about things that matter with people doing the work Gary Direnfeld, MSW, RSW

2 Why Talk?  Working in the area of domestic violence has particular challenges and rewards  The challenges can threaten the integrity of the worker  The rewards can provide a tremendous sense of personal satisfaction  Talking can help overcome the challenges and improve the likelihood of reward.

Challenges Include Certain Risks  Risk of attack  Risk of burnout  Risk of psychological stress reactions

You can get hurt Did You Know  More than 1/2 of social workers in Massachusetts * have been physically assaulted in a work related incident (assaults range from pushing, hitting, and choking to life-threatening attacks)  More than 3/4 have been verbally abused  More than 1/3 have had a weapon brought into the workplace  Over 3/4 have been frightened, even without physical or verbal threat or assault * Based upon a survey of 1,000 Massachusetts NASW members and review of literature.

Violence Is Unacceptable  Violence, threats and abuse to staff are unacceptable.  This includes sexual and racial harassment, and threats to family and property.

Promoting Safety  a statement of the organization's policy that clearly sets out a code of practice that fits your job and where you work  clear assessments of the risk to you from the individuals, families and groups you work with  clear procedures about what to do when you think there is a risk, what to do after an incident, and what follow-up there will be  training that fits your job, including what responsibilities you have towards colleagues and to service users  a working environment that maximizes your safety  support in dealing with your concerns about threats, abuse and violence  procedures for making sure precautions are working and can be reviewed  easily available support after an incident that fits what you and others who were involved need to recover from the experience.

Burnout  The term "burnout" has been applied across helping professions and refers to the cumulative psychological strain of working with many different stressors. It often manifests as a gradual wearing down over time. National Center for Post-Traumatic Stress Disorder

Factors Contributing To Burnout Professional isolation Emotional drain from empathizing Difficult client population Long hours with few resources Ambiguous success Unreciprocated giving and attentiveness Failure to live up to one's own expectations for effecting positive change National Center for Post-Traumatic Stress Disorder

Symptoms Include  Depression  Cynicism  Boredom  Loss of compassion  Discouragement National Center for Post-Traumatic Stress Disorder

Treatment and Prevention  Proper diet, nutrition and rest  Physical activity  Social action  Good supervision  Realistic goals  Realistic workload  Variety in caseload  Collegial support  Taking holidays!

Hearing Horrendous Stories Can Hurt the Listener  Secondary Traumatic Stress Stamm 1995 Sub-clinical or clinical signs of PTSD that mirror those experienced by trauma clients  Compassion Stress/Fatigue Figley 1995 Sense of helplessness, confusion, isolation or secondary traumatic stress symptoms experienced by the worker  Vicarious Traumatization Pearlman and Saakvitne 1995 Permanent transformative, inevitable changes that result from work with trauma survivors Cognitive schemata – e.g personal safety in the world or relationships

Treatment and Prevention  Same as for burnout and  Debriefing specific horrific cases  Counselling  Learning to set personal boundaries to keep from acting beyond your role  Stress management strategies such as yoga  Limiting alcohol in favor of health promoting activities

Compassion Satisfaction Figley also discusses the “upside” of working with trauma clients:  Sense of strength  Self-knowledge  Confidence  Sense of meaning  Spiritual connection  Respect for human resiliency

Self Care It’s OK to have fun!

…and more fun

Clinical Stories with Issues of DV: An Open Forum Talk amongst your peers and agency staff, discuss the challenges, arrive at mutually acceptable solutions and HAVE FUN! Gary Direnfeld, MSW, RSW